Dr. Guyuron’s Migraine Surgery, 5 Years Later

James11 February 2011

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Back in June of 2005 we were talking about a surgery for migraine disease being pioneered by Dr. Bahman Guyuron. Dr. Guyuron has been involved in surgical procedures in the USA and Canada for many years, most notably in the area of plastic surgery. It was while he was doing plastic surgery that he discovered that some of his patients were finding relief from their migraine attacks.

So he tested a surgical technique to target some trigger areas for migraine. First, each patient is "tested" with botulinum toxin A (Botox). The Botox treatment confirms the target sites.

Then comes the main surgery. The surgery removes tiny bits of muscle or nerves in the head, to relieve the pressure on certain nerves, thus eliminating triggers in some people. Sometimes other minor procedures are used.

69 of Dr. Guyuron’s patients were followed up throughout the following five years. The results are looking good.

These are, of course, very good results. Now, it should be noted that only certain patients would be approved for this type of surgery. However, it is likely that most of these patients had tried many other things without success.

Also, 10 patients (out of 79) were removed from the study because they required further surgery (they’re not included in the above chart).

Usually, surgery is not recommended for migraine. You will try many of the other options available before you should even consider surgery. Dr. Guyuron himself looks for people who have at least two or three severe attacks each month that do not respond to medications.

The recovery time for this surgery is about two to three weeks. As with any surgery, there is some risk, but problems with procedures like this tend to be rare.

Related posts:

Most headache specialists are reluctant to recommending this type of surgery. The selection process by Dr. Guyuron includes treatment with Botox first. Only those who respond to Botox are considered good candidates for surgery. Well, if someone responds to Botox it’s probably better to keep injecting Botox rather than doing surgery. Studies have shown that of people with daily headache half are free of headaches two years later, even without treatment. But with repeated Botox injections sustained relief occurs sooner and in a higher percentage of patients. Here are some of my arguments against surgery: http://www.nyheadache.com/blog/?p=114

This is a good opportunity to mention, yet again, a very important principle. Just because a treatment is effective does not mean that it’s the best treatment. It’s very important that you look into the options that you have and, with your doctor, choose the ones that are best for you, that are lowest risk for you, that are the best long term options.

As Dr. Mauskop points out in his blog post, surgery, even minor surgery, carries significant risks. So do Botox injections, but they’re different kinds of risks. Even common medications and herbal treatments carry risks.

Know the risks, talk to your doctor, and never get carried away by the latest press release and study. Look at the big picture.

It’s encouraging to see good results in a study like this, even if it just means that it’s a step in the direction of a future treatment. But there are a lot of excellent non-surgical treatments out there, and the majority will hopefully be helped significantly without surgery.

I had Dr. Guyuron’s surgery right after he started doing it. At first it seemed to help, but not long later I realized that it hadn’t helped much at all. I’ve had botox several times since and it didn’t help either. The one thing that has helped me is the drug Zonagran. I took it only 3 days and it cut my severe migraine pain so much that I barely have pain when I get a migraine. I get them a lot less frequently also.

l had the surgery by Dr. Guyuron 5 weeks ago, and I am wondering if I should have. I was at the end of my rope after 16 years of chronic pain. I couldn’t just sit and watch my life go by anymore. I prayed this would help, but so far I am in more pain than I was beforehand. The surgery is extremely painful, especially the temples. They have you do this outpatient, but I beg of you to stay in a hospital for at least the first night. I didn’t, and I hope this is the reason for the complications in my post-op pain, but Dr. Guyuron would never admit to this, as he certainly did not admit me when my Dr. back home said, by al my accounts, he should have. He saw me everyday, and for the first three I couldn’t walk by myself; I could barely open my eyes.
I had all four trigger points done, which includes the septoplasty. I’ll also admit to a rhinoplasty. I know a lot of people don’t admit to it, but he says when he does septoplasties he does rhinoplasties with them 75% of the time, and I believe him. He did do an amazing job on my nose, but I couldn’t tell you if the rhinoplasty was painful because I was in so much pain from everything else. (I was bracing myself for the pain of the rhinoplasty after reading how painful it could be. I was bruised badly, but that was the only downside). 5 weeks later my post-op pain is so bad that it has obviously made my migraines worse. My head feels like a watermelon, but it is completely numb to the touch. Anyplace I am finally getting feeling back is so sore it hurts to brush my hair. (Washing my hair is almost unbearable).
I didn’t think this, my migraines getting worse, was possible. There was no evidence I saw that said anything could happen but failure, and I had to take the chance. Now I’m on daily pain meds after years of trying to stay off them.
I am praying that I will get better and that this is a REALLY big bump in the road because I honestly don’t know what I’ll do if I stay like this. I do feel butchered. I am crying as I write this, but I also know that if I heal back to my usual state of disability, I would have still taken the chance. All of a sudden my entire youth had passed me by, and my twin brother and all my high school friends are getting married and having kids. I had this surgery for the chance of a quasi-normal life. I never did this to eliminate my pain, because I knew that to be impossible, and he didn’t promise that. I did it because I needed a chance at life. When I left Cleveland, he said I would have at least 50% less pain. I’m in 50% more pain right now.
Having said all of this, I have heard success stories, but I couldn’t find anyone specific. I reached one woman who ha her temples and a septoplasty done, and she was much improved, but she was the only migraine patient of his I could get a hold of.
I have a Skype with him next week and I hope he is helpful about all the pain I am experiencing from the operation, but he did seem completely surprised when I was suffering so much in Cleveland, which was odd then and really odd now that I have read the other post. He made me feel like I was an aberration. I do believe he made a big mistake by not putting me in the hospital right after surgery. (I’m pretty sure my body went into shock from the pain, so as I said, please stay overnight in the hospital he works with; he does not have a facility where you can do this and will try and all you out of it; don’t listen!
I had my parents take care of me for the 9 days I was there. They were scared to death. I think they went into shock too.
You need to have somebody to take care of you, especially if you are having a bunch of sites. You’ll have tubes that need changing etc.
I’ll reiterate the fact that I had to do something, and this surgery, after much research, seemed like the best option. I pray every day that I’ll be better than I was when I went in, or at the least, than what I am now.
Ashley Pindyck[email protected][email protected] .com

Please feel free to email me. I might not get back to you as soon as you’d like because of my pain, but I needed answers beforehand I never got.

After reading Ms. Pindyck’s account, I was wondering if there have been any successes with this surgery that make it worthwhile. I would expect that had this worked well, people would be shouting it from the roof tops, yet scouring the web I see very few who even mention it other than as something to follow. It has been a year since this blog and 5 months since her post. Any other comments?

I had this surgery a year ago to relieve my migraines. I had tried everything. I had suffered from migraines for eight years and it was beginning to seriously interfere with my daily life. I had to call off of work, miss family gatherings, fail exams because I couldn’t study because the pain was too intense. I would get, on average, 14 migraines a month. After the surgery, I was reduced to 3 a month. Mainly, the pain would begin in my temples and radiate from there. I was skeptical about getting this surgery at first because many believed it was such a drastic move. After a year, I am very happy with the results. The surgery definitely helped with the frequency of my migraines.

I had the surgery with Dr Amirlak in Texas . He is the main guy doing these now and I have had full response . I used to get daily migraines and was miserable , I still get 1-2 migraines every couple of months but easily relieved with tylenol . I got my life back with this surgery

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